Identification of Latent Subgroups of Obese Adolescents Enrolled in a Healthy Weight Management Program

In obesity research, it is assumed that the population is homogeneous. While this approach has yielded important insights, testing this supposition might reveal information that could impact our understanding of the phenomena and its treatment. In this study, data from obese teenagers (N = 248, Mean BMI percentile = 99%; Mean age = 13.9, SD = 1.8) who were predominantly minority (n = 182), female (n = 169), and enrolled in a weight loss intervention were analyzed. Latent profile analysis (LPA) was used to segment patients into groups based on their scores on PedsQL 4.0 scales (physical-, emotional-, social-, and school functioning) and the Coopersmith Self-Esteem Scale. A 3-class solution was parsimonious and demonstrated the best statistical fit (Bayesian information criterion = 10596.96; Lo-Mendell-Rubin-adjusted likelihood ratio test = 73.020, p \u3c .05). The 3 groups were ordinal and composed of respondents with high- (HF; n = 72, 29%), medium- (MF; n = 110, 44%), and low functioning (LF; n = 66, 27%). Further analyses (chi squares and linear regressions) showed that the LF group had a significantly higher proportion of Caucasians and males compared to the HF (referent) group. Also, when controlling for demographics and weight, the LF group had significantly higher blood pressure (diastolic and systolic), lower self-reported physical activity (on two different measures), and a higher total score on a scale of depressed mood. Four groups of ordinal regressions (since the pair of self-reported exercise variables and blood pressure variables were correlated, only one from each pair was included in each set) consistently found that self-reported physical activity and blood pressure improved significantly from the LF to HF groups. However, when depressed mood was included, it became the only significant variable. These findings suggest that LF group members are demographically and clinically distinct and that depressed mood may be the critical factor connecting self-report and metabolic dysfunction. Theory suggests depressed mood is both associated with cognitive schemas that affect responses on self-report measures; skewing them negative, and is also manifested metabolically

Predictors of Binge Eating among Bariatric Surgery Candidates: Disinhibition as a Mediator of the Relationship Between Depressive Symptoms and Binge Eating

Background—Current and lifetime psychopathology is common in adult patients seeking bariatric surgery, with major depressive disorder and binge eating disorder affecting a higher proportion of this group than the general population. While depressive symptoms have been previously associated with eating pathology, potential mediators of this relationship are not well understood. Methods—This study used a naturalistic, retrospective design to investigate cognitive and behavioral aspects of eating behavior (cognitive restraint, disinhibition, and hunger) as potential mediators of the relationship between depressive symptoms and binge eating within a sample of 119 adult patients (82.4% female; 96.6% white; mean age = 47 years) seeking bariatric surgery (Rouxen-Y and sleeve gastrectomy) at a large university medical center. Patients completed a standardized presurgical psychological evaluation to determine appropriateness for bariatric surgery as part of routine clinical practice. Binge eating was assessed via clinician rating (number of binge eating episodes per week) based on DSM-IV diagnostic criteria and self-report measures (Binge Eating Scale) in order to account for potential methodological differences. Depressive symptoms were assessed using the Beck Depression Inventory. Results—Depressive symptoms were a significant predictor of binge eating, disinhibition, and hunger. However, only disinhibition emerged as a significant mediator of the relationship between depressive symptoms and binge eating. Conclusions—Behavioral disinhibition, or a tendency toward overconsumption of food and challenges restraining impulses associated with a loss of control eating, may represent an important variable in determining the relation between depressive symptoms and binge eating, in bariatric surgery patients

Longitudinal trends in food cravings following Roux-en-Y gastric bypass in an adolescent sample

This is the author's accepted manuscript. Made available by the permission of the publisher.Background Food cravings are more prevalent and potentially problematic for many individuals with obesity. Initial evidence suggests that bariatric surgery has some short-term beneficial effects on cravings in adults, but little is known about the effect on adolescents or the trajectory beyond 6 months. Methods The purpose of the present study was to determine the longitudinal effect of Roux-en-Y gastric bypass (RYGB) on food cravings in a sample of adolescents with severe obesity (body mass index (BMI) ≥40 kg/m2). Sixteen adolescents were recruited and underwent RYGB. Participants completed the Food Craving Inventory before RYGB, and 3, 6, 12, 18, and 24 months postoperatively. The present study took place in a single pediatric tertiary care hospital. Results RYGB produced a negative (cravings decreased as time increased) nonlinear trend for total food cravings as well as for each individual subscale (sweets, high fat foods, carbohydrates, fast food) over the 24-month study period. This means that while cravings decrease postsurgically, there is a decline in the slope with the line reaching asymptote at approximately 18 months. BMI change was not a significant predictor of food cravings, but low statistical power may account for this lack of significance. Conclusion These findings provide preliminary evidence that RYGB decreases food cravings in adolescents

Bariatric Surgery Outcomes in Appalachia Influenced by Surgery Type, Diabetes, and Depression

Background Most effective treatment for morbid obesity and its comorbidities is bariatric surgery. However, research is limited on weight loss and associated outcomes among patients in Appalachia. The objective of this study was to examine demographic and comorbidity influence on surgical outcomes of this population including age, sex, race, state of residence, education, marital status, body mass index (BMI kg/m2), excess body weight (EBW), percent excess weight loss (%EWL), blood pressure, diagnosed depression, diagnosed type 2 diabetes (T2D), Beck Depression Inventory-II (BDI-II), and laboratory values (i.e., hemoglobin A1c). Methods A retrospective electronic medical record (EMR) data extraction was performed on N = 582 patients receiving bariatric surgery (laparoscopic Roux-en-Y gastric bypass [RYGB] and laparoscopic sleeve gastrectomy [SG]) between 10/2013 and 2/2017. Results Patient population was 92.5% Caucasian, 79.3% female, 62.8% married, 45 ± 11.1 years, 75.8% received RYGB, and 24.2% received SG. Average %EWL from baseline to 1-year follow-up was 68.5 ± 18.4% (n = 224). In final descriptive models, surgery type, diagnosed T2D, HbA1c, and depressive symptoms were significant covariates associated with lower %EWL. Conclusions Findings suggest patients completing surgery within an Appalachian region have successful surgical outcomes at 1-year post-surgery, as indicated by significant reductions of \u3e 50% EWL, regardless of other covariates. Results suggest that bariatric programs should consider paying special consideration to patients with T2D or depressive symptoms to improve outcomes. Results have potential to inform future prospective studies and aid in guiding specific interventions tailored to address needs of this unique population

Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric Surgery

Background—Factors contributing to adolescents’ non-completion of bariatric surgery, defined as self-withdrawal during the preoperative phase of care, independent of program or insurance denial, are largely unknown. Recent adolescent and adult bariatric surgery literature indicate that psychological factors and treatment withdrawal play a role; however, for adolescents, additional age-salient (family/caregiver) variables might also influence progression to surgery. Objectives—The present study examined demographic, psychological, and family/caregiver variables as predictors of whether adolescents completed surgery (“completers”) or withdrew from treatment (“non-completers”). Setting—Adolescents were from a bariatric surgery program within a pediatric tertiary care hospital. Methods—A retrospective chart review was conducted of consecutive patients who completed bariatric surgery psychological intake evaluations from September 2009 to April 2013. Data involving completer (n = 61) versus non-completer (n = 65) status were analyzed using two-tailed independent t tests, Chi-squared tests, and logistic regressions. Results—Forty-three percent of adolescents completed surgery, similar to adult bariatric samples. Significantly more males were non-completers (p \u3c .05), and there was a trend towards non-completion for older adolescents (p = 0.06). No other demographic, psychological, or caregiver/family variables were significant predictors of non-completion. Conclusions—These findings indicate that demographic variables, rather than psychological or family factors, were associated with the progression to or withdrawal from surgery. Further assessment is needed to determine specific reasons for completing or withdrawing from treatment, particularly for males and older adolescents, to improve clinical care and reduce attrition

Psychological Diagnoses and Weight Loss among Appalachian Bariatric Surgery Patients

Background. The relationship between presurgical psychopathology and weight loss following bariatric surgery is complex; previous research has yielded mixed results. The current study investigates the relationship among presurgical mental health diagnoses, symptom severity, and weight loss outcomes in an Appalachian population, where obesity-related comorbidities are prominent. Methods. A retrospective chart review was performed on bariatric surgery patients in an accredited Appalachian centered academic hospital in northern West Virginia between 2013 and 2015 (n = 347). Data extraction included basic demographics, anthropometrics (percent excess weight loss (%EWL)) at six-month, one-year, and two-year postoperative visits, and two validated psychological questionnaires (Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI)) from patient’s presurgical psychological evaluation. Results. Average patient population was 92.5% Caucasian, 81.5% female, 45 ± 11.5 years old, and 84.1% who underwent laparoscopic Roux-en-Y gastric bypass surgery with the remaining having laparoscopic sleeve gastrectomy. At baseline, no differences were detected in weight, excess body weight, or body mass index between surgery types. Average baseline BDI-II score was 10.1 ± 8.68 (range 0–41) and BAI score was 6.1 ± 6.7 (range 0–36), and this was not significantly different by surgery at baseline. Both baseline psychological scores were in the “minimal” severity range. BDI-II was positively related to BMI of patients at baseline (p=0.01). Both BDI-II and BAI were not significantly related to %EWL across follow-up. Conclusion. Other than baseline weight, BDI-II and BAI scores were not related to %EWL outcomes in patients receiving bariatric surgery in the Appalachian region. Future work should examine mixed methods approaches to capture prospective and longitudinal data to more thoroughly delve into mental health aspects of our Appalachian patients and improve efforts to recapture postoperative patients who may have been lost to follow-up

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population